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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006400
Report Date: 08/14/2026
Date Signed: 08/14/2026 07:03:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2026 and conducted by Evaluator Jenifer Tirre
COMPLAINT CONTROL NUMBER: 22-AS-20260807100406
FACILITY NAME:MG HEIGHTS IFACILITY NUMBER:
306006400
ADMINISTRATOR:RICO, CAROLYNEFACILITY TYPE:
740
ADDRESS:10612 LEXINGTON STREETTELEPHONE:
(657) 298-3008
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:5CENSUS: 3DATE:
08/14/2026
UNANNOUNCEDTIME BEGAN:
05:45 PM
MET WITH:Caregiver Dulce MaderoTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Facility is in financial distress.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced complaint visit into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. On 8/13/26 LPA made a complaint investigation visit and observed deficiencies that are being cited today.

During the course of the investigation, LPA toured the facility and interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as Personnel Report, Resident physicians reports, Emergency Identification information, Water Bill Notice, Cable bill notice, Resident Admission Agreement, and Grocery Receipts.
Regarding the allegation Facility is in financial distress, the investigation revealed the following: Per Observations, Department observed facility Cable & Phone service was cut off. LPA Tirre observed television only received a few channels, Staff was unable to scan documents via email due to internet shut off and LPA called the facility main landline number to which a message replies “The number you are calling is out of service”. CONTINUED ON 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20260807100406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MG HEIGHTS I
FACILITY NUMBER: 306006400
VISIT DATE: 08/14/2026
NARRATIVE
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Per interviews the following was revealed: Per staff interview with Staff 1 (S1), Staff stated they had asked Licensee for money to purchase groceries on several occasions. S1 stated that when they did receive a credit card to use for groceries, the card would decline due to no funds. S1 stated that on multiple occasions they have purchased groceries for facility with their own money or have shared their own private food with residents at facility in order to feed residents. Staff 1 also stated that they had been given partial payment for working month of July. S1 stated that there is still a remainder due for employment. Interview with witness 1 (W1) states that Licensee hasn’t paid rent in full for several months. W1 states that Licensee makes partial payments or late payments in regards to rent.

Per Record Review, a Notice for water to be scheduled for shut off by 5:00PM on August 13, 2026 was issued for non payment. Another Notice for Cable/internet/ Phone was provided that stated connection was shut off due to non payment. Department also reviewed six 3 Day Eviction notices issued by Landlord on dates 5/11/26, 5/18/26,6/23/26, 7/13/26,7/20/26, 8/6/26 for late payment of rent were issued to Licensee.

Based on the information gathered in investigation, the preponderance of evidence has been met. The following is being cited per Title 22 Regulations.



An exit interview was conducted with Caregiver and report provided to facility representative.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260807100406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MG HEIGHTS I
FACILITY NUMBER: 306006400
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2026
Section Cited
CCR
87213
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87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by:
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POC is for Licensee to make payment on rent by 8/17/26, phone bill by 8/18/26 and water bill on 8/28/26. Licensee also to provide proof of receipt for groceries for 8/15/26. Proof of POC is due on coordinating dates for each bill beginning on 8/17/26. Proof of POC’s are to be sent to LPA.
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 Based on LPA observation of delinquent notices and payments on rent & utilities being shut off for several days. This poses an immediate health & safety risk for the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
LIC9099 (FAS) - (06/04)
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